How is Muscle Invasive Bladder Cancer Diagnosed?

If your healthcare provider believes you have MIBC, you may be referred to a urologist. Your urologist will perform a full medical history and physical exam. Further tests may be needed to form a diagnosis. If your diagnosed with bladder cancer, you may need additional tests. These tests will find out the stage of your disease. It will also give your doctor an idea of what treatment is best for you.

Tests for MIBC

The following tests most likely will be done:

  • Urine cytology. The color and content of your urine will be checked. This test will also look at body cells under a test for cancer cells.
  • Blood tests: A comprehensive metabolic panel (CMP), which includes kidney and liver function tests will be among the blood tests your doctor will order.
  • A Computerized tomography scan (also known as CT or CAT scans) with a bladder scope "cystoscopy" are often good enough to diagnose bladder cancer.
  • Cystoscopy: A doctor will use a thin tube that has a light and camera at the end of it (cystoscope) to pass through the urethra into the bladder. It allows your doctor to see inside the bladder cavity. Usually your doctor will use a flexible cystoscope and a local anesthetic for your exam in the office. The doctor will take a tissue sample with a cystoscope in the operating room. Taking the tissue at this time will allow your doctor to look at the cells. The tissue sample will be sent to a laboratory where they will find out the stage of your cancer. This will help with choosing the right treatment.
  • Rigid cystoscopy: The scope that the doctor uses when you are put to sleep is not flexible like the one used in the office, but rigid. This means that it is straight and does not bend. This cystoscope is bigger, has a light at the end, and surgical instruments can pass through it. This allows for more extensive work like the transurethral resection of bladder tumor (TURBT) described below.

Diagnosis of bladder cancer is confirmed when the doctor sees the tumor through a cystoscope and during transurethral resection of a bladder tumor (TURBT) described below. You will likely be put to sleep for these exams. At this time your doctor will stage your cancer and try to cut it away. They will also see whether the cancer has spread.

  • Transurethral resection of bladder tumor (TURBT). This is a very important procedure for accurate tumor typing, staging and grading. Your doctor can look inside the bladder, take tumor samples and resect (cut away) what he/she sees of your tumor.
  • Blue light cystoscopy. For this test, your doctor uses a catheter to place an imaging solution into your bladder through your urethra. The solution is left in the bladder for about an hour. The doctor then uses the cystoscope to inspect the bladder with regular white light and then with blue light. The bladder cancer cells show up better with blue light.

Imaging Tests

These tests help diagnose and stage bladder cancer.

  • Retrograde pyelogram: This test uses x-rays to look at your bladder, ureters and kidneys. The test is done during a cystoscopy.
  • Magnetic resonance imaging (MRI): These tests use a powerful magnetic field, radio waves and a computer to produce detailed pictures of the inside of your body.
  • If your chest, abdomen or pelvic image results are abnormal or if it is not possible to get a lymph node biopsy, your doctor may order a positron emission tomography (PET) scan.

For the PET scan, you will be given a special drug (a tracer) through your vein or you may inhale or swallow the drug. Your cells will pick up the tracer as it passes through your body. When the scanner passes over the bladder, the tracer allows your doctor to better see where and how much the cancer is growing.